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Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.

Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.

The pre and early post natal is a period high susceptible to environmental insults for instance nutrition. There is a high metabolic demand necessary for the multiplication and differentiation of cells for the formation of tissues and organs and unbalanced diets affect metabolism at long term. The present study aimed to analyze physiological and metabolic parameters in male offspring submitted to the low protein diet in the perinatal life followed by a normoprotein diet or kept on the same maternal low protein diet after weaning. 12 female Wistar rats were matched with male of same strainand according maternal diet forming normoproteic and low-protein groups during gestation and lactation. At weaning three groups were randomly formed: CC (control-control), LP (low-protein-low protein) and LPC (low-protein-control). Somatic growth, feed intake, organ weight, biochemical parameters, liver fat, blood cell count and glucose tolerance test were analysed. The post-weaning "nutritional recovery" diet improved body mass and longitudinal length. But, the maintenance with low protein diet post weaning caused weight and length deficiency (P

This study was conducted to evaluate the effects of a low-protein (LP) diet supplemented with sodium butyrate (SB), medium-chain fatty acids (MCFAs) and n-3 polyunsaturated fatty acids (PUFAs) on nutrient utilization and lipid and amino acid metabolism in weaned pigs. A total of 120 Duroc × Landrace × Yorkshire pigs (initial body weight: 7.93 ± 0.65 kg) were randomly assigned to five dietary treatments, including the control diet (CON), LP diet, LP + 0.2% SB diet (LP + SB), LP + 0.2% MCFA diet (LP + MCFA) and LP + 0.2% n-3 PUFA diet (LP + PUFA). The results show that the LP + MCFA diet increased (p < 0.05) the digestibility of dry matter and total P in pigs compared with the CON and LP diets. In the liver of the pigs, the metabolites involved in sugar metabolism and oxidative phosphorylation significantly changed with the LP diet compared with the CON diet. Compared with the LP diet, the altered metabolites in the liver of the pigs fed with the LP + SB diet were mainly associated with sugar metabolism and pyrimidine metabolism; the altered metabolites in the liver of pigs fed with the LP + MCFA and LP + PUFA diets were mainly associated with lipid metabolism and amino acid metabolism. In addition, the LP + PUFA diet increased (p < 0.05) the concentration of glutamate dehydrogenase in the liver of pigs compared with the LP diet. Furthermore, the LP + MCFA and LP + PUFA diets increased (p < 0.05) the mRNA abundance of sterol regulatory element-binding protein 1 and acetyl-CoA carboxylase in the liver compared with the CON diet. The LP + PUFA diet increased (p < 0.05) mRNA abundances of fatty acid synthase in the liver compared with the CON and LP diets. Collectively, the LP diet supplemented with MCFAs improved nutrient digestibility, and the LP diet supplemented with MCFAs and n-3 PUFAs promoted lipid and amino acid metabolisms.

Background: Classical homocystinuria (HCU) is an inborn defect of methionine metabolism caused by a deficiency of the enzyme cystathionine β-synthase (CBS). The main symptoms of classical homocystinuria are lens subluxation, bone lesions, vascular disease and developmental delay/intellectual disability. The treatment method for HCU is a methionine-poor diet supplemented with amino acid preparations. The aim of the study was to examine the relationship of dietary factors, metabolic compensation and selected skeletal parameters in patients with HCU. Methods: Bone mineral density measurements (DXA) were performed in pediatric patients with HCU, and blood levels of selected amino acids, minerals and vitamins, as well as dietary nutritional value, were analyzed. Results: A total of 11 patients with HCU whose median age was 9.3 years were enrolled in the study. The median DXA total body less head of HCU patients was −0.4 z-score, and the lumbar spine was −1.4 z-score. Despite supplementation, calcium intake was below the age norm. Average vitamin D3 intake was in line with recommendations, but 36% of patients had reduced blood levels. Bone mineral density depended on blood levels of 25-hydroxyvitamin D, homocysteine and methionine, as well as on BMI, age and intake of natural protein (R2 = 98.5%, p = 0.015; R2 = 86.7%, p = 0.0049) and protein from an amino acid preparation (r = 0.69, p = 0.026). Conclusion: The results of the study indicate the need for regular densitometry in patients with HCU and also the use of additional calcium and vitamin D3 supplementation. It is also necessary to perform a comprehensive analysis of the diet and metabolic controls.

Exogenous proteases are promising to stimulate the application of low-protein diets for broilers. A total of 540 1-day-old Arbor Acres male broilers were randomly assigned to 9 groups with 6 replicates of 10 birds. A 3 × 3 factorial, completely randomized arrangement was used to evaluate the effects of dietary crude protein (CP) and protease levels on growth and slaughter performance, immunity capacity, and apparent ileal digestibility (AID) of amino acids (AA). Dietary CP levels were 20.0%, 19.5%, or 19.0% during the starter phase, and 18.0%, 17.5%, or 17.0% during the finisher phase. Protease levels were 0, 250, or 500 mg/kg in diets throughout the trial. The trial lasted for 42 days. Weight gain and feed efficiency of broilers decreased as dietary CP lowered, but improved with protease supplementation. Dietary CP and protease levels had few effects and interactions on carcass characteristics, immune organ indexes, and immunoglobulin concentrations. The AID of most AA was improved by dietary CP decrease or protease supplementation. In conclusion, reducing dietary CP decreased the performance and immune capacity of broilers but increased the AID of AA. Almost independent of dietary CP level, dietary protease addition improved the performance of broilers, probably through the enhancement of AA digestibility, and had no effect on carcass traits.

Ruminants are one of the largest anthropogenic methane and nitrous oxide emissions. Therefore, the hypothesis was to study the effects of reducing dietary crude protein (CP) level on environmental contaminators when rumen-protected amino acids and choline chloride were supplemented. Sixty Holstein dairy cows were used during the experiment. Test diets were: (1) CD = Control diet with16.2 g of crude protein/ Kg of DM); (2) LM = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine ; (3) LL = Low protein diet with 14.2 g of crude protein/ Kg of DM + lysine; (4) LML = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine + lysine; (5) LMLC = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine + lysine + choline. Dry matter and NDF intake were not different, but the control group received higher CP and ADF compared with other groups (P < 0.05). Fecal CP and ADF of control group were lower (P < 0.05), but no differences were observed for fecal dry matter (DM) and NDF. Milk yield and protein content were higher for LML and LMLC like control group (P < 0.05). Nitrogen intake, urinary N, urinary urea N and total excreta N decreased (P < 0.05) when animals fed low protein. There was no difference in ruminal pH and acetate to propionate ratio, whereas the ruminal ammonia-N decreased with the low protein (P < 0.05). The 120-h gas production test, showed no difference on the kinetics of digestion and in vitro methane emission. However, the inclusion of DMI in the calculations revealed that low protein can reduce (P < 0.05) methane emission. Overall, our findings indicated that low protein can be compensated for by adding rumen-protected amino acids, not only to maintain the animal performance, but also to decrease nitrogen excretion and methane emission. Os ruminantes são uma das maiores emissões antropogênicas de metano e óxido nitroso. Portanto, a hipótese foi estudar os efeitos da redução do nível de proteína bruta (PB) na dieta sobre os contaminantes ambientais quando aminoácidos protegidos no rúmen e cloreto de colina foram suplementados. Sessenta vacas leiteiras Holstein foram utilizadas durante o experimento. As dietas teste foram: (1) CD = dieta controle com 16.2 g de proteína bruta / Kg de MS); (2) LM = Dieta pobre em proteínas com 14.2 g de proteína bruta / Kg de DM + metionina; (3) LL = Dieta pobre em proteínas com 14.2 g de proteína bruta / Kg de MS + lisina; (4) LML = Dieta pobre em proteínas com 14.2 g de proteína bruta / Kg de DM + metionina + lisina; (5) LMLC = Dieta pobre em proteínas com 14.2 g de proteína bruta / Kg de DM + metionina + lisina + colina. O consumo de matéria seca e FDN não foi diferente, mas o grupo controle recebeu maior PB e FDA em comparação com os outros grupos (P < 0.05). A PB e FDA fecal do grupo controle foram menores (P < 0.05), mas não foram observadas diferenças para matéria seca (MS) e FDN fecal. A produção de leite e o teor de proteína foram maiores para LML e LMLC como grupo controle (P < 0.05). A ingestão de nitrogênio, N urinário, N urinário urinário e N excreta total diminuíram (P < 0.05) quando os animais foram alimentados com baixa proteína. Não houve diferença no pH ruminal e na relação acetato / propionato, enquanto o N-amônia ruminal diminuiu com o baixo teor de proteína (P < 0.05). O teste de produção de gás de 120 h, não mostrou diferença na cinética de digestão e emissão de metano in vitro. No entanto, a inclusão do CMS nos cálculos revelou que a baixa proteína pode reduzir (P < 0.05) a emissão de metano. No geral, nossos resultados indicaram que o baixo teor de proteína pode ser compensado pela adição de aminoácidos protegidos no rúmen, não apenas para manter o desempenho animal, mas também para diminuir a excreção de nitrogênio e a emissão de metano.

International audience; Purpose Protein synthesis and proteolysis are known to be controlled through mammalian target of rapamycin, AMP-activated kinase (AMPK) and general control non-derepressible 2 (GCN2) pathways, depending on the nutritional condition. This study aimed at investigating the contribution of liver AMPK and GCN2 on the adaptation to high variations in protein intake. Methods To evaluate the answer of protein pathways to high- or low-protein diet, male wild-type mice and genetically modified mice from C57BL/6 background with liver-specific AMPK- or GCN2-knockout were fed from day 25 diets differing in their protein level as energy: LP (5%), NP (14%) and HP (54%). Two hours after a 1 g test meal, protein synthesis rate was measured after a C-13 valine flooding dose. The gene expression of key enzymes involved in proteolysis and GNC2 signaling pathway were quantified. Results The HP diet but not the LP diet was associated with a decrease in fractional synthesis rate by 29% in the liver compared to NP diet. The expression of mRNA encoding ubiquitin and Cathepsin D was not sensitive to the protein content. The deletion of AMPK or GCN2 in the liver did not affect nor protein synthesis rates and neither proteolysis markers in the liver or in the muscle, whatever the protein intake. In the postprandial state, protein level alters protein synthesis in the liver but not in the muscle. Conclusions Taken together, these results suggest that liver AMPK and GCN2 are not involved in this adaptation to high- and low-protein diet observed in the postprandial period.

High protein diet (HPD) is an affordable and positive approach in prevention and treatment of many diseases. It is believed that transcriptional regulation is responsible for adaptation after HPD feeding and Kruppel-like factor 15 (KLF15), a zinc finger transcription factor that has been proved to perform transcriptional regulation over amino acid, lipid and glucose metabolism, is known to be involved at least in part in this HPD response. To gain more insight into molecular mechanisms by which HPD controls expressions of genes involved in amino acid metabolism in the liver, we performed RNA-seq analysis of mice fed HPD for a short period (3 days). Compared to a low protein diet, HPD feeding significantly increased hepatic expressions of enzymes involved in the breakdown of all the 20 amino acids. Moreover, using KLF15 knockout mice and in vivo Ad-luc analytical system, we were able to identify Cth (cystathionine gamma-lyase) as a new target gene of KLF15 transcription as well as Ast (aspartate aminotransferase) as an example of KLF15-independent gene despite its remarkable responsiveness to HPD. These findings provide us with a clue to elucidate the entire transcriptional regulatory mechanisms of amino acid metabolic pathways.

Chronic kidney disease (CKD) is a global burden in the world. Low protein diet (LPD) recommendation is suggested in CKD patients to avoid or defer dialysis initiation and slow down CKD progression. However, nutritional imbalance and protein energy wasting represent key worries. The amino acid-based metabolic profile may provide a sensitive biomarker to evaluate CKD patients' nutrition status with LPD recommendations.We conducted a cross-sectional study in CKD stage 3-5 patients who had received LPD recommendation to evaluate the association between LPD and traditional markers (including plasma levels of albumin, pre-albumin, transferrin, total iron-binding capacity), inflammation markers (including peripheral leukocyte count and plasma levels of high-sensitivity C-reactive protein), body composition, muscle strength, and physical function, and novel nutrition markers (including amino acid-based metabolic profile) in CKD stage 3-5 patients.In our study CKD stage 3-5 patients with the total number of 73, the mean age was around 71 ± 10 years old. The mean daily protein intake (DPI) was around 0.9 ± 0.3 g/kg/day and 25 (34%) patients met the recommended goal of DPI0.8 g/kg/day. The mean daily calorie intake (DCI) was around 23 ± 6 kcal/kg/day, with only 11 (15%) patients met the recommend DCI with 30-35 kcal/kg/day. Compared to CKD patients with non-LPD, patients with LPD had significantly lower hemoglobin and albumin levels, shorter 6-min walking distance (6MWD), and lower leucine levels. Multivariable analysis found that lower hemoglobin and leucine levels, and shorter 6MWD were negatively and independently associated with LPD (all p 0.05). Then ROC curve analysis found that the optimal cut-off value of leucine plasma levels was 95.5 μM with 60% sensitivity and 71% specificity to predict those CKD patients with LPD with the area under the curve of 0.646 (95% CI: 0.512-0.780).LPD attainment was noted in 34% patients and most of CKD stage 3-5 patients (around 85%) had inadequate daily calorie intake although receiving standard dietary counseling routinely. A low protein diet and inadequate daily calorie intake in CKD patients were associated with shorter 6MWD, and lower hemoglobin and leucine levels. Plasma leucine levels lower than 95.5 μM may be a herald for muscle wasting and malnutrition in these CKD stage 3-5 patients with inadequate calorie intake.

Tumors of the intestinal tract are among the most common tumor diseases in humans, but, like many other tumor entities, show an unsatisfactory prognosis with a need for effective therapies. To test whether nutritional interventions and a combination with a targeted therapy can effectively cure these cancers, we used the fruit fly Drosophila as a model. In this system, we induced tumors by EGFR overexpression in intestinal stem cells. Limiting the amount of protein in the diet restored life span to that of control animals. In combination with a specific EGFR inhibitor, all major tumor-associated phenotypes could be rescued. This form of treatment was also successful in a real treatment scenario, which means when they started after the full tumor phenotype was expressed. In conclusion, reduced protein administration can be a very promising form of adjuvant cancer therapy.

International audience; Amino acids are involved in energy homeostasis, just as are carbohydrates and lipids. Therefore, mechanisms controlling protein intake should operate independently and in combination with systems controlling overall energy intake to coordinate appropriate metabolic and behavioural responses. The objective of this study was to quantify the respective roles of dietary protein and carbohydrate levels on energy balance, plasma FGF21 and IGF-1 concentrations, and hypothalamic neurotransmitters (POMC, NPY, AgRP and CART). In a simplified geometric framework, 7-week-old male Wistar rats were fed 12 diets containing 3 to 30% protein for 3 weeks, in which carbohydrates accounted for 30 to 75% of the carbohydrate and fat part of the diet. As a result of this study, most of the studied parameters (body composition, energy expenditure, plasma FGF21 and IGF-1 concentrations and Pomc/Agrp ratio) responded mainly to the protein content and to a lesser extent to the carbohydrate content in the diet.

Feeding low-protein (LP) diets with essential amino acids could be an effective strategy for ruminants from economic, health and environmental perspectives. This study was conducted to investigate the effects of rumen-protected methionine and lysine (RML) in the LP diet on growth performance, innate immunity, and gut health of growing lambs. After 15 days of adaption, sixty-three male Hulunbuir lambs aged approximately 4 months were allotted to three dietary groups and each group had three pens with seven lambs for 60 days. The dietary treatments were as follows: a normal protein diet (14.5% CP, positive control; NP), LP diet (12.5% CP, negative control; LP), and LP diet with RML (12.5% CP, LP + RML). Lambs fed with LP + RML diet showed improved villus architecture and gut barrier function than those fed with the other two diets. The mRNA expressions of interleukin-1β, tumor necrosis factor-α, interferon-γ, toll-like receptor-4, and myeloid differentiation primary response 88 were downregulated in most regions of the intestinal segments by feeding the LP + RML diet. Compared with the NP diet, feeding lambs with the LP diet increased the abundance of Candidatus_Saccharimonas in all regions of the intestinal tract and reversed by feeding the LP + RML diet. Lambs in the LP + RML diet group had lower abundance of Erysipelotrichaceae_UCG-009 and Clostridium_sensu_stricto_1 than those in the LP diet group. The results showed that supplementing RML in the LP diet exhibited beneficial effects on host immune function, intestinal mucosal integrity, and microbiota composition. • Adding methionine and lysine in a low-protein diet improve the intestinal mucosal growth and integrity. • Feeding a low-protein diet with methionine and lysine enhance the innate immune status. • Adding methionine and lysine in a low-protein diet alter the intestinal microbiota composition.

This study investigates the mechanism by which maternal protein restriction induces hepatic autophagy-related gene expression in the offspring of rats. Pregnant Sprague-Dawley rats were fed either a control diet (C, 18 % energy from protein) or a low-protein diet (LP, 8·5 % energy from protein) during gestation, followed by the control diet during lactation and post-weaning. Liver tissue was collected from the offspring at postnatal day 38 and divided into four groups according to sex and maternal diet (F-C, F-LP, M-C and M-LP) for further analysis. Autophagy-related mRNA and protein levels were determined by real-time PCR and Western blotting, respectively. In addition, chromatin immunoprecipitation (ChIP) was performed to investigate the interactions between transcription factors and autophagy-related genes. Protein levels of p- eukaryotic translation initiation factor 2a and activating transcription factor 4 (ATF4) were increased only in the female offspring born to dams fed the LP diet. Correlatively, the mRNA expression of hepatic autophagy-related genes including Map1lc3b, P62/Sqstm1, Becn1, Atg3, Atg7 and Atg10 was significantly greater in the F-LP group than in the F-C group. Furthermore, ChIP results showed greater ATF4 and C/EBP homology protein (CHOP) binding at the regions of a set of autophagy-related genes in the F-LP group than in the F-C group. Our data demonstrated that a maternal LP diet transcriptionally programmed hepatic autophagy-related gene expression only in female rat offspring. This transcriptional programme involved the activation of the eIF2α/ATF4 pathway and intricate regulation by transcription factors ATF4 and CHOP.

The article presents an overview of the up-to-date statistics on the incidence of chronic kidney disease (CKD) in Ukraine and worldwide. Nowadays, the main etiological factor of CKD in the world is diabetes and concomitant diabetic nephropathy, which is a complex multifactorial disease affecting multiple organs and systems. In Ukraine, the major part of these patients has CKD stage IV–V, which corresponds to the glomerular filtration rate (GFR) of 15–29 and < 15 ml/min/1.73 m2, respectively. Glycemic control and antihypertensive therapy are the primary links of the disease management in pre-dialysis, along with low-protein and low-carb diet. The key issue in treating these patients is that diet restrictions in pre-dialysis may lead to unfavorable consequences in terms of general nutritional status of the patient, so it is important to overcome this issue without interfering with patient’s biochemical status and avoiding the risk of loss of kidney function. The administration of ketoanalogues of essential amino acids in pre-dialysis is demonstrated to be effective in restoration of amino acid profile with protein anabolism, decreasing urea concentration in the blood and correcting mineral status. The positive effect is observed in patients with GFR, В статье представлен обзор современной статистики заболеваемости хронической болезнью почек (ХБП) в Украине и мире. На сегодняшний день ведущим этиологическим фактором ХБП в мире является сахарный диабет (СД) и сопутствующая ему диабетическая нефропатия, которая является сложным мультифакторным заболеванием с множественным поражением органов и систем организма. При этом в Украине значительная часть таких пациентов находится на стадии ХБП IV–V, что соответствует уровню СКФ 15–29 и < 15 мл/мин/1,73 м2 соответственно. Контроль гликемии и антигипертензивная терапия являются первичными звеньями ведения заболевания на додиализном этапе наряду с диетой с низким содержанием белка и углеводов. Ключевым вопросом в ведении таких пациентов является то, что диетические ограничения на додиализном этапе могут иметь нежелательные последствия для общего питательного статуса пациента, поэтому важна их коррекция без вмешательства в биохимический профиль пациента с избеганием повышенного риска потери функции почки. Назначение кетоновых аналогов аминокислот на додиализном этапе демонстрирует эффективность в восстановлении аминокислотного баланса с анаболизмом белка, снижая концентрацию мочевины в крови и корригируя минеральный статус. Позитивный эффект наблюдается при СКФ < 25 мл/мин/1,73 м2, тогда как задокументированные преимущества начинаются с уровня СКФ < 30 мл/мин/1,73 м2 и наиболее выражены у пациентов с СКФ < 15 мл/мин/1,73 м2., У статті подано огляд сучасної статистики захворюваності на хронічну хворобу нирок (ХХН) в Україні та світі. На сьогодні провідним етіологічним чинником ХХН у світі є цукровий діабет (ЦД) та супутня йому діабетична нефропатія, що є складним мультифакторним захворюванням із множинним ураженням органів та систем організму. При цьому в Україні значна частка цих пацієнтів знаходиться на стадії ХХН IV–V, що відповідає ШКФ 15–29 та < 15 мл/хв/1,73 м2 відповідно. Контроль глікемії та антигіпертензивна терапія є первинними ланками в управлінні захворюванням на додіалізному етапі разом із дієтою з низьким умістом білка й вуглеводів. Ключовим питанням у веденні таких пацієнтів є те, що дієтичні обмеження на додіалізному етапі можуть мати небажані наслідки для загального нутритивного статусу пацієнта, тому важливим є вирішення питання про їх корекцію без втручання в біохімічний профіль пацієнта та уникаючи підвищеного ризику втрати функції нирки. Призначення кетонових аналогів амінокислот на додіалізному етапі демонструє ефективність у відновленні амінокислотного балансу з анаболізмом білка, знижуючи концентрацію сечовини в крові та коригуючи мінеральний статус. Позитивний ефект спостерігається при ШКФ < 25 мл/хв/1,73 м2, задокументовані переваги починаються з рівня ШКФ < 30 мл/хв/1,73 м2 та найбільш виражені в пацієнтів із ШКФ < 15 мл/хв/1,73 м2.

A maternal low-protein (LP) diet during gestation and/or lactation results in metabolic syndrome in their offspring. Here, we investigated the effect of maternal LP diet during puberty and adulthood on the metabolic homeostasis of glucose and lipids in offspring. Female mice were fed with normal-protein (NP) diet or a LP diet for 11 weeks. Male offspring were then fed with a high-fat diet (NP-HFD and LP-HFD groups) or standard chow diet (NP-Chow and LP-Chow groups) for 4 months. Results showed that maternal LP diet during puberty and adulthood did not alter the insulin sensitivity and hepatic lipid homeostasis of their offspring under chow diet, but aggravated insulin resistance, hepatic steatosis, and hypercholesterolemia of offspring in response to a post-weaning HFD. Accordingly, transcriptomics study with offspring’s liver indicated that several genes related to glucose and lipid metabolism, including lipoprotein lipase (Lpl), long-chain acyl-CoA synthetase 1 (Acsl1), Apoprotein A1 (Apoa1), major urinary protein 19 (Mup19), cholesterol 7α hydroxylase (Cyp7a1) and fibroblast growth factor 1 (Fgf1), were changed by maternal LP diet. Taken together, maternal LP diet during puberty and adulthood could disarrange the expression of metabolic genes in the liver of offspring and aggravate insulin resistance and hepatic steatosis in offspring fed a HFD.

The objective of this study was to evaluate the effects of low-protein (LP) diets supplemented with sodium dichloroacetate (DCA) and glucose (GLUC) on metabolic markers and intestinal microbiota of finishing pigs. A total of 80 crossbred growing barrows were allocated randomly to one of the five treatments, including the normal protein level diet (CON), the LP diets, LP with 120 mg/kg DCA (LP + DCA) or 1.8% glucose (LP + GLUC), and LP with 120 mg/kg DCA and 1.8% glucose (LP + DCA + GLUC). The LP diet increased the plasma HDL, triglyceride, and cholesterol concentrations and reduced the bile acid, urea nitrogen, albumin, and total protein concentrations compared to the CON diet (p < 0.05). The LP + DCA + GLUC diet reduced the plasma VLDL, triglyceride, and cholesterol concentrations and increased the bile acid concentration compared with the LP diet (p < 0.05). Pigs fed the LP + DCA and LP + GLUC diets showed reduced 3-Hydroxy-3-Methylglutaryl-CoA Reductase content and increased Cytochrome P450 Family 7 Subfamily A Member 1 activity of liver compared that of the CON diet (p < 0.05). Moreover, the LP diets with or without DCA and GLUC supplementation increased the relative abundance of colonic microbiota related to carbohydrate fermentation in finishing pigs. In conclusion, 120 mg/kg DCA or 1.8% GLUC supplementation in an LP diet modulated the hepatic lipid metabolism of pigs, while the DCA along with GLUC supplementation likely improved the lipid metabolism by stimulating bile acid secretion.

Improving carbohydrate utilization can contribute to sustainability of aquaculture. In order to explore the feedback mechanism of glucose homeostasis in fish, one control diet (25% carbohydrate and 40% protein), one relatively high carbohydrate diet named HG (42% carbohydrate and 40% protein), and one high dietary carbohydrate coupled with relatively low protein diet named HGP (42% carbohydrate and 25% protein) were fed to grass carp for 40 days. After the feeding trial, HG group impeded the food intake and growth performance of fish compared with the other two groups. Meanwhile, the serum glucose and insulin level were both significantly elevated under the condition of high carbohydrates intake when compared HG with control group. However, although no significant difference was observed in peripheral glucose or insulin between HG and HGP groups, fish fed with HGP diet increased growth performance and food intake compared with the HG group. Gene expression data indicated that fish selectively regulated the expressions of the cerebral anorexigenic genes (cart and pomc) to adapt to the HG and HGP intake. Therefore, the HGP diet with high carbohydrate and low protein was more suitable for grass carp feeding and growth when compared with the other two diets, possibly because the diet composition was closer to the natural food of this fish. In addition, the serum leptin level was highly consistent with changes in food intake and anorexigenic gene expressions when comparing the three experimental diets, indicating that leptin might be the key to mediate the feedback regulation of carbohydrates intake on food intake and appetite in fish.

The study aims to evaluate the effects of feeding different protein levels on the resumption of postpartum ovarian activity by measuring serum estradiol (E2) and progesterone (P4) concentrations bi-weekly starting one week postpartum in three genotypes of sheep (Yankasa, Uda and Balami). Eighteen (18) multiparous sheep with aged range of 2.5 – 3 years old consisting of six (6) each of Yankasa, Uda and Balami breeds were divided into three groups and reared on different protein concentrations. The protein concentrations were 15.2% (high), 9.5% (medium) and 6.5% (low). Results showed a gradual increase of estradiol in both Yankasa and Uda breeds fed low protein diet from 100 – 3000 concentration. However, Uda breed had the highest value of estradiol when both medium and high protein diets were fed to the three genotypes of sheep. Nevertheless, Yankasa sheep had more consistent values of progesterone when fed low protein diet compared to Balami and Uda. Also Uda breed recorded the highest progesterone values in both medium and high protein diets among the three genotypes followed by Yankasa sheep. All the three genotypes returned to estrous earlier on high protein concentration followed by those on medium protein level. It is concluded that increase protein concentration hastened resumption of ovarian cyclicity and thereby leading to increase fertility in sheep

Background and objectives: The purpose of this study was to evaluate the relationship between the total salivary protein concentration and dietary habits in Caries-free, Early childhood Caries and Severe Early Childhood Caries children. Materials and methods: The present study included Thirty children who were divided into three groups. They were further divided into Caries-free, Early childhood Caries and Severe Early Childhood Caries with 10 children in each group. Information was collected regarding oral hygiene practices, feeding habits and dietary pattern through a face-to-face interview with the parent/caretaker of the child. Unstimulated saliva was collected and total protein concentration was estimated. Multivariate logistic regression analysis was performed to assess the relative contributions of dietary and feeding patterns between children with and without ECC. ANOVA was done to identify the difference in mean protein concentration between the groups. Results: Risk factors specific to the ECC group were Breast feeding

Background Kidney functional reserve (KFR), the only clinical kidney stress test, is not routinely measured because the complexity of measurement has limited clinical application. We investigated the utility of plasma cystatin C (CysC) after oral protein loading (PL) to determine KFR in Stages 3 and 4 chronic kidney disease (CKD). Methods Following a 24-h low-protein diet, KFR was measured after oral protein by hourly plasma CysC and compared with simultaneous creatinine clearance (CrCl) and radionuclide 99technetium diethylenetriaminepentaacetatic acid (Tc-99m-DTPA) measured glomerular filtration rate (mGFR) measurement in an observational, single-centre cohort study of adults with CKD Stages 3 and 4. Subjects were followed for 3 years for fast (F) or slow (S) CKD progression, dialysis requirement or death or a combination of major adverse kidney events (MAKEs). Result CysC, CrCl and Tc-99m-DTPA mGFR measurements of KFR in 19 CKD Stage 3 and 21 CKD Stage 4 patients yielded good agreement. KFR was not correlated with baseline kidney function. Eight CKD Stage 3 (42%) and 11 CKD Stage 4 (52%) subjects reached their lowest serum CysC concentration 4 h after PL. CysC KFR and baseline serum creatinine (sCr) predicted death or dialysis or MAKE-F with a respective area under the curve (AUC) of 0.73 [95% confidence interval (CI) 0.48–0.89] and 0.71 (95% CI 0.51–0.84). Including CysC KFR, age, baseline sCr and nadir CysC predicted a decrease in sCr-estimated GFR >1.2 mL/min/year (MAKE-S) with an AUC of 0.89. Conclusions Serial CysC avoided timed urine collection and radionuclide exposure and yielded equivalent estimates of KFR. Serial CysC may facilitate monitoring of KFR in clinical practice.

A 56-day feeding trial was conducted with Clarias gariepinus fingerlings to evaluate the effects of alternate mixed feeding schedules of normal and low protein diets on growth and feed utilization. Two experimental diets with crude protein levels of 45% (Diet A – normal protein) and 35% (Diet B – low protein) were prepared using locally available feed ingredients. Four different feeding schedules were implemented: Diet A throughout (T1), 1-day Diet A followed by 1-day Diet B (T2), 2-days Diet A followed by 1-day Diet B (T3), and 1-dayDietA followed by 2-days Diet B (T4). The fish were fed 5% of their body weight twice daily throughout the experiment. The results showed no significant difference in the growth and feed utilization parameters except for the protein efficiency ratio. T4 recorded the highest value for weight gain, specific growth rate, feed and protein efficiency ratio. Similarly, T4 recorded the best feed conversion ratio. Hence, the study showed that alternate feeding of normal and low protein diets has no negative effect on fish growth performance with a possibility of reducing feed cost.

Fetal growth restriction can affect health outcomes in postnatal life. This study tested the hypothesis that the response to an inflammatory pulmonary insult is altered in pediatric fetal growth restricted rats. Using a low-protein diet during gestation and postnatal life, growth-restricted male and female rats and healthy control rats were exposed to an inflammatory insult via the intratracheal instillation of heat-killed bacteria. After 6 h, animal lungs were examined for lung inflammation and status of the surfactant system. The results showed that in response to an inflammatory insult, neutrophil infiltration was decreased in both male and female rats in the growth-restricted animals compared with the control rats. The amount of surfactant was increased in the growth-restricted animals compared with the control rats, regardless of the inflammatory insult. It is concluded that fetal growth restriction results in increased surfactant and altered neutrophil responses following pulmonary insult.

Made available in DSpace on 2021-06-25T10:25:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 In a large part of the population inefficient ingestion of proteins, whether for cultural, aesthetic or economic reasons, is a global concern. Low-protein diets can cause severe functional complications, mainly during the development and maturation of organs and systems, including the female reproductive system. The present study investigated the effect of nutritional protein restriction during puberty on the oestrous cycle and expression of sex steroid receptors (AR, ERα e ERβ) in ovarian and uterine tissues of adult rats. Protein restriction promoted lower body weight gain, feed efficiency and higher caloric intake. There was an increase in the oestrus phase arrest without changing the total length of the oestrous cycle. The consumption of low-protein diet also reduced the thickness of the uterine endometrium (uterine epithelium and endometrial stroma) in addition to increasing the number of primary and atretic follicles in the ovaries. Furthermore, the low-protein diet reduced the levels of androgen receptor (AR) and increased the oestrogen receptor β (ERβ) in the ovary, while no significant changes were observed in the uterus. Our study reinforces the importance of adequate protein intake during puberty, since physiological changes in this developmental period interfere with the histomorphometry of the ovaries and uteri, possibly resulting in impaired folliculogenesis and fertility in the reproductive period. Department of Structural and Functional Biology Institute of Biosciences UNESP - São Paulo State University Graduate Program in Nutrition Institute of Biosciences of Botucatu UNESP Department of Structural and Functional Biology Institute of Biosciences UNESP - São Paulo State University Graduate Program in Nutrition Institute of Biosciences of Botucatu UNESP

Serine and glycine are 2 of the first-affected nonessential amino acids in low crude protein (CP) diets for pigs. Therefore, we explored the effects of different dietary serine-to-glycine ratios on growth performance and lipid metabolism in growing-finishing pigs. A total of 160 crossbred healthy barrows, with a similar body weight of around 59.50 kg, were randomly allotted into 1 of 5 treatments (8 pens per treatment and 4 pigs per pen). The serine-to-glycine ratios of the 5 dietary treatments were as follows: diet A (NORMAL group), 1.18:1 (16% CP); diet B (LOW group), 1.2:1 (12% CP); diet C (S2G1 group), 2:1 (12% CP); diet D (S1G2 group), 1:2 (12% CP); and diet E (S1G1 group), 1:1 (12% CP).We found that the pigs fed a low CP diet (12% CP), when maintaining serine-to-glycine ratio at 1:2 and a total amount of 1.44%, had the same average daily gain as the pigs fed a normal CP diet (16% CP) (P > 0.05), but they had increased intramuscular fat (P

The aim of the study was to investigate the microscopic renal changes resulting from the concurrent administration of chloroquine and ethanol, with inadequate dietary protein using rats. Sixty-four rats were randomly distributed into eight groups of eight rats each: control groups on normal protein (NPC) or low protein diet (LPC); chloroquine treatment groups on normal protein (NPQ) or low protein diet (LPQ); ethanol treatment groups on normal protein (NPE) or low protein diet (LPE); concurrent chloroquine and ethanol treatment groups on normal protein (NPQE) or low protein diet (LPQE). Chloroquine in 0.9% normal saline was administered weekly to NPQ, LPQ, NPQE, and LPQE. While NPE, LPE, NPQE and LPQE received 6% ethanol in drinking water ad libitum, NPC and LPC received 0.9% normal saline and plain drinking water. After treatment, routine haematoxylin and eosin stain, Masson's trichrome stain for collagen, kidney volume estimation, glomeruli count, immunofluorescence for aquaporin 2 and urine volume estimation were conducted. The results showed a decreased kidney volume in all the experimental groups compared to the control. There was increased collagen fiber deposition and distortion of renal histology in the experimental groups compared to control. Concurrent administration of chloroquine and alcohol causes distortion of kidney histology and derangements of renal function in the low protein-fed rats and can cause kidney failure.

The present study investigated the effect of Azomite (AZO) on the growth performance, nutrient utilisation, and bone mineralisation of broilers fed low protein diet. A total number of 180 one-day-old male chicks were randomly distributed to three treatment groups having six replicates of 10 birds each. Experimental diets included; positive control (PC) with 21.5% CP (starter) and 19.0% CP (finisher), negative control (NC) with 2% lower CP than PC in each period and treatment group (AZO-0.25) in which NC was supplemented with 0.25% AZO. Azomite significantly (p .05) higher in NC. Azomite improved the digestibility of dry matter (DM), crude protein (CP), apparent metabolisable energy (AME), calcium (Ca) and phosphorus (P) (p

For patients with inflammatory bowel disease, cow’s milk allergy, and lactose intolerance, soymilk is a potential alternative to cow’s milk. In this study, we aimed to identify the effects of a soy protein-based low-protein diet on the body and organ weights and the gut microbiome of six-week-old mice fed a diet containing 20% (SP) or 5% (LP) soy protein for 14 days via 16S rRNA (V4) amplicon sequencing. Body weight gain (growth) and liver, spleen, and fat tissue weight were significantly suppressed by the LP diet. Operational taxonomic unit numbers and α-diversity were lower in the LP group than in the SP group. A principal coordinate analysis revealed differences in the gut microbiome compositions of SP and LP mice. The abundances of caecal Roseburia sp., Alistipes sp., and bacteria from the family Muribaculaceae were lower in the LP group than in the SP group. In contrast, the abundance of Desulfovibrionaceae, which is positively correlated with inflammation, was higher in the LP group than in the SP group. These results differed from the effects of a milk casein-based low-protein diet (reported previously). Based on these findings, we conclude that the undesirable effects of a low-protein diet and/or protein deficiency are related to changes in the gut microbiome composition and may differ depending on the kind of proteins used.

Background: Gen1 mutation can cause various phenotypes of congenital anomaly of the kidney and urinary tract (CAKUT). An intrauterine low-protein isocaloric diet can also cause CAKUT phenotypes in offspring. However, single factors such as gene mutation or abnormal environmental factor during pregnancy can only explain part of the pathogenesis of CAKUT. Objectives: A low-protein isocaloric diet was fed to Gen1-mutant mice throughout pregnancy to establish a Gen1-mutant mouse model exposed to a low-protein isocaloric intrauterine environment. The mice were divided into 4 groups: normal (22%) protein diet (ND) + wild-type mice (CON group), ND + Gen1PB/+ mice (Gen1PB/+ group), low (6%)-protein isocaloric diet (LD) + wild-type mice (LD group), and the LD + Gen1PB/+ groups. Methods: The experimental design included observing proportion and distribution of CAKUT phenotypes of neonatal mice; evaluating the number of ureteric buds (UBs) on embryonic day (E) 11.5, the location of UBs on E11.5, and length of the common nephric duct (CND); isolating embryonic kidneys on E11.5 from the Gen1PB/+ group and culturing embryonic kidneys in medium containing 10% serum or serum-free medium to observe the branching of UBs; and detecting the p-PLCγ, p-Akt, and p-ERK1/2 in UBs and CND on E11.5, as well as the apoptosis and proliferation of tissues by immunofluorescence staining. Results: We found that the incidence of CAKUT in offspring of Gen1PB/+ mice under an intrauterine low-protein isocaloric diet environment was significantly increased, and a duplicated collecting system was the dominant phenotype of CAKUT. During the early stage of metanephric development, ectopic protrusion of UBs may appear and lower locations of UBs in Gen1PB/+ mice under an intrauterine low-protein isocaloric diet environment and the number of UB branches in the serum-free culture condition significantly decreased. Further examination revealed that p-PLCγ signaling and tissue apoptosis were abnormal in UBs and the CND at the early stage of kidney development. Conclusions: The aforementioned findings suggest that an intrauterine low-protein isocaloric diet can aggravate the occurrence of CAKUT in Gen1-mutant mice, which might affect key steps in the metanephric development, such as the protrusion of UBs, which might be related to mediate UBs and CND apoptosis through p-PLCγ signaling.

This study was conducted to evaluate the effects of dietary supplementation of Bacillus licheniformis derived-protease, alone or in combination with valine to low protein diet on growth performance, nutrient digestibility and carcass quality grade in growing-finishing pigs. A total of 180 crossbred ([Landrace × Yorkshire] × Duroc) growing pigs with an initial body weight of 22.56 ± 1.59 kg were used in a 17-week feeding trial. Pigs were randomly allotted into three treatments: CON, basal diet; PROT, low protein diet with 0.05% protease; PROTV, PROT diet with 0.08% valine. During the finishing phase (wk 7–17) and overall period (wk 0–17), gain: feed (G:F) ratio was increased (P

Background/aim The effects of dietary protein and carbohydrate content on the plasma amino acid profile of patients with diabetes are not fully understood. Therefore, we examined whether there are effects of diets with differing proportions of protein and carbohydrate on the plasma amino acid concentrations of control (CT) mice and mice with type 2 diabetes (db). Materials and methods We used db mice as an animal model of type 2 diabetes which are genetically deficient in leptin receptor. Diets with differing proportions of protein and carbohydrates (L diet: low protein/carbohydrate ratio, H diet: high protein/carbohydrate ratio) were supplied. db Mice were fed with a restriction on the basis of the consumption by CT-L mice, such that equivalent amounts of energy and fat were consumed. In CT mice fed the L or H diets, there was no significant difference in ad libitum food intake. Results There were significant interactions between diet and genotype with respect to water intake, urine volume, urinary glucose concentration, and plasma isoleucine, leucine, valine, branched-chain amino acids, and serine concentrations. db-H mice showed significantly higher water intake, urine volume, and urinary glucose than db-L mice. db Mice fed the L or H diets had similar plasma amino acid profiles, except for valine. In contrast, CT-H mice showed significantly higher valine and branched-chain amino acids and lower serine concentrations than CT-L mice. Thus, the CT-H mice were more similar to db mice fed either of the diets. Conclusion There were different effects of the dietary protein or carbohydrate content on the plasma amino acid profiles between nondiabetic and diabetic mice. In particular, the profiles in nondiabetic conditions were different between the low- and high-protein diet conditions.

Background: Although associations between low protein diet (LPD) and changes of gut microbiota have been reported; however, systematic discernment of the effects of LPD on diet-microbiome-host interaction in patients with chronic kidney disease (CKD) is lacking. Methods: We searched PUBMED and EMBASE for articles published on changes of gut microbiota associated with implementation of LPD in CKD patients until July 2021. Independent researchers extracted data and assessed risks of bias. We conducted meta-analyses of combine p-value, mean differences and random effects for gut microbiota and related metabolites. Study heterogeneity was measured by Tau2 and I2 statistic. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Five articles met inclusion criteria. The meta-analyses of gut microbiota exhibited enrichments of Lactobacillaceae (meta-p= 0.010), Bacteroidaceae (meta-p= 0.048) and Streptococcus anginosus (meta-p< 0.001), but revealed depletion of Bacteroides eggerthii (p=0.017) and Roseburia faecis (meta-p=0.019) in LPD patients compared to patients undergoing normal protein diet. The serum IS levels (mean difference: 0.68 ug/mL, 95% CI: -8.38-9.68, p= 0.89) and pCS levels (mean difference: -3.85 ug/mL, 95% CI: -15.49-7.78, p < 0.52) did not change between groups. We did not find significant differences on renal function associated with change of microbiota between groups (eGFR, mean difference: -7.21 mL/min/1.73 m2, 95% CI: -33.2-18.79, p= 0.59; blood urea nitrogen, mean difference: -6.8 mg/dL, 95% CI: -46.42-32.82, p= 0.74). Other clinical (sodium, potassium, phosphate, albumin, fasting sugar, uric acid, total cholesterol, triglycerides, C-reactive protein and hemoglobin) and anthropometric estimates (body mass index, systolic blood pressure and diastolic blood pressure) did not differ between the two groups. Conclusions: This systematic review and meta-analysis suggested that the effects of LPD on the microbiota were observed predominantly at the families and species levels but minimal on microbial diversity or richness. In the absence of global compositional microbiota shifts, the species-level changes appear insufficient to alter metabolic or clinical outputs.

We recently reported that dietary cystine maintained plasma mercaptalbumin levels in rats fed low-protein diets. The present study aimed to compare the influence of low-protein diets supplemented with cystine and methionine, which is another sulfur amino acid, on plasma mercaptalbumin levels in rats. Male Sprague–Dawley rats were fed a 20% soy protein isolate diet (control group), 5% soy protein isolate diet (low-protein group) or 5% soy protein isolate diet supplemented with either methionine (low-protein + Met group) or cystine (low-protein + Cyss group) for 1 week. The percentage of mercaptalbumin within total plasma albumin of the low-protein + Met group was significantly lower than that of the control and low-protein + Cyss groups. No significant differences in the mRNA levels of tumor necrosis factor-α, interleukin-6, interleukin-1β, and cyclooxygenase 2 in blood cells were observed between the low-protein + Met and low-protein + Cyss groups. Treatment with buthionine-(S,R)-sulfoximine, an inhibitor of glutathione synthesis, did not influence the percentage of mercaptalbumin within total plasma albumin in rats fed the low-protein diet supplemented with cystine. These results suggest that supplementation with cystine may be more effective than that with methionine to maintain plasma mercaptalbumin levels in rats with protein malnutrition. Cystine might regulate plasma mercaptalbumin levels via the glutathione-independent pathway.

The objective of this study was to investigate the effects of low-protein diets with low digestibility of feed ingredients on intestinal damage and to explore whether the protease supplementation can alleviate the damage in Pekin ducks. A total of 576 Pekin ducklings (6 replicate pens, 16 ducks/pen) were randomly assigned to 6 dietary treatments (3 × 2 factorial arrangement) in a randomized complete block design. Factors were CP levels (13.5%, 15.5%, and 17.5%) and protease (0 or 20,000U/kg). Compared with the diets containing 17.5% CP, low-protein diets (13.5% CP) showed suppressed (P

Patients with phenylketonuria (PKU) require a phenylalanine/protein-restricted diet, with limited food choice. Interpreting food labels, calculating protein intake, and determining food suitability are complex and confusing tasks. A mobile multi-media low-protein diet app was developed to guide food choice, label interpretation, and protein calculation. ‘PKU Bite’® includes >1100 specialist and regular low-protein foods, is colour-coded for suitability, and features a protein calculator. A 12-week randomised controlled trial assessed app efficacy, compared with written/pictorial material, in 60 parents/caregivers of children with PKU, aged 1–16 years, and 21 adolescents with PKU. Questionnaires examined self-efficacy and label-reading knowledge; food records evaluated natural-protein intake, compared with prescriptions. There was no difference between groups in label-reading knowledge or self-efficacy, but there was a trend for improved accuracy of dietary protein calculation, when using the app (baseline/12-weeks: app 35%/48%; control 39%/35%). Parents of children

During chronic kidney disease (CKD), typical alterations in the gut microbiota are observed. The kidney no longer plays the role of the main excretory organ as this function is performed by the intestine. In CKD patients, an alteration of intestinal permeability and a degradation of the protective mucous layer are observed. These changes in the intestinal barrier allow the passage of bacterial material from the intestine to the bloodstream through the intestinal wall. This phenomenon contributes to the induction of the chronic inflammatory state, typical of CKD. In nephropathic patients, there is an increase in circulation of p-cresyl sulfate (p-CS), indoxyl sulphate (IS), indole-3 acetic acid (IAA) and trimethylamine-N-oxide (TMAO), all gut-derived uremic toxins. The changes in gut microbiota composition are related to CKD stage and this phenomenon is exacerbated in hemodialysis (HD) adult and pediatric patients. Interestingly, it is observed a positive shift in gut microbiota composition after renal transplantation and at the same time a reduction of circulating gut-derived uremic toxins. Either gut dysbiosis or uremic toxins accumulation contribute to the CKD onset and progression.

A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) actually benefit from a DPI of ≤ 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1–3 has not been consistent. We systematically searched MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, as well as the bibliographies of articles identified in the search, for eligible randomized controlled trials that had investigated the effects of LPD (prescribed DPI

A 56 days feeding trial was conducted to investigate the effects of enzyme-treated soy protein (ETSP) supplementation in low protein diets on immune function of immune organs (head kidney, spleen and skin) in on-growing grass carp. A total of 540 on-growing grass carp (initial average weight: 325.72 ± 0.60 g) were fed six diets, which included a normal protein diet (28% crude protein) and five low protein diets (26% crude protein) supplemented with graded levels of ETSP (0.0, 0.8, 1.2, 1.6 and 2.0%). At the end of feeding period, a challenge test was performed by infection with Aeromonas hydrophila for two weeks. The results indicated that (1) reducing dietary protein content from 28 to 26% decreased antibacterial substances and aggravated inflammatory responses of above three immune organs; (2) under the condition of reducing protein level in diet, 0.8–1.2% ETSP supplementation reversed these above adverse effects on immune function of above three immune organs; (3) suitable ETSP supplementation-decreased inflammatory responses were partly associated with [IκB kinase β (IKKβ)/inhibitor of κBα (IκBα)/nuclear factor kappa B (NF-κB) p65 and p52 or NF-κB p65] signaling and [target of rapamycin (TOR)/(S6K1, 4E-BP)] signaling in above three immune organs. (4) On the basis of C3 content (head kidney), C4 content (spleen) and skin hemorrhage and lesion, the optimal ETSP supplementation levels in low protein diets were estimated to be 1.48%, 1.61% and 1.03%, respectively. In summary, ETSP supplementation in low protein diets improved immune function of head kidney, spleen and skin in on-growing grass carp.

The global prevalence of chronic kidney disease (CKD) is increasing with the ag ing of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the pro gression of kidney dysfunction, the diet of patients with CKD should be an im portant consideration in their care. Many guidelines recommend limiting pro tein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Giv en the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.

The effects of defattedMoringa oleiferaseed (L) on haemotological indices and body weight was evaluated in rat model of Protein Energy Malnutrition (PEM). Protein Energy Malnutrition is associated with muscle degeneration and anaemia. Protein Energy Malnutrition (PEM) was induced in fifteen (15) rats by feeding them with low protein diet (3% fish meal protein) and water for twenty eight days. Five (5) rats served as positive control (Group A) received commercial feed containing 21% crude protein. The PEM rats were assigned to three groups namely B, C and D. Group B and C were fed with recovery diets ad libitum for another twenty eight days. Group B received feed containing 20% Fishmeal protein and Group C received feed containing 20% defattedM. oleifera seed. Group D were Protein-energy malnourished rats maintained on protein deficient diet (3% fish meal protein). Protein energy malnourished rats had significantly reduced (pM. oleiferain place of 3% fishmeal caused significant (pM. oleiferaseeds ameliorate muscle degeneration and anaemia in PEM rats comparatively similar to 20% fish meal.

For patients with advanced chronic kidney disease (CKD) appropriately chosen and timely initiated dietary measures, as a complement to drug therapy, may slow the progression of the disease and delay the need for dialysis treatment. According to the results, dietary protein restriction may play a very important in management of such a patient. The effect of low protein diet is given by the early initiation and well cooperation of patients. The low protein diet with supplementation of ketoanalogues of amino acids is an attractive intervention to help maintain good nutritional status of patients and also have a positive role in calcium phosphate metabolism. Depending on the level of CKD´s progression it should not be forgotten either the fluid balance and the limitation of the intake of salt and phosphorus in the diet which may also have an unfortunate effect on the course of the disease.

Maternal low-protein diet (LP) throughout gestation affects pancreatic β-cell fraction of the offspring at birth, thus increasing their susceptibility to metabolic dysfunction and type 2 diabetes in adulthood. The present study sought to strictly examine the effects of LP during the last week of gestation (LP12.5) alone as a developmental window for β-cell programming and metabolic dysfunction in adulthood. Islet morphology analysis revealed normal β-cell fraction in LP12.5 newborns. Normal glucose tolerance was observed in 6- to 8-wk-old male and female LP12.5 offspring. However, male LP12.5 offspring displayed glucose intolerance and reduced insulin sensitivity associated with β-cell dysfunction with aging. High-fat diet exposure of metabolically normal 12-wk-old male LP12.5 induced glucose intolerance due to increased body weight, insulin resistance, and insufficient β-cell mass adaptation despite higher insulin secretion. Assessment of epigenetic mechanisms through microRNAs (miRs) by a real-time PCR-based microarray in islets revealed elevation in miRs that regulate insulin secretion (miRs 342, 143), insulin resistance (miR143), and obesity (miR219). In the islets, overexpression of miR143 reduced insulin secretion in response to glucose. In contrast to the model of LP exposure throughout pregnancy, islet protein levels of mTOR and pancreatic and duodenal homeobox 1 were normal in LP12.5 islets. Collectively, these data suggest that LP diet during the last week of pregnancy is critical and sufficient to induce specific and distinct developmental programming effects of tissues that control glucose homeostasis, thus causing permanent changes in specific set of microRNAs that may contribute to the overall vulnerability of the offspring to obesity, insulin resistance, and type 2 diabetes.

Primary hyperammonaemia is a term to describe an elevation of ammonia in blood or plasma due to a defect within the urea cycle, which is the pathway responsible for ammonia detoxification and arginine biosynthesis. Urea cycle disorders (UCDs) are rare diseases caused by genetic defects affecting any of the six enzymes or two transporters that are directly involved in the urea cycle function. The clinical situation is variable and largely depends on the time of onset. Newborns who are often affected by hyper-ammonaemic encephalopathy carry a potential risk of severe brain damage, which may lead to death. Outside the neonatal period, symptoms are very unspecific but most often neurological (with wide variability), psychiatric and/or gastrointestinal. Early identification of patients is extremely important to start effective treatment modalities immediately. The acute management includes detoxification of ammonia, which often requires extracorporeal means such as haemodialysis, and the use of intravenous drugs that work as nitrogen scavengers. Long-term management of patients with UCDs consists of a low-protein diet, which needs to be balanced and supplemented to avoid deficiencies of essential amino acids, trace elements or vitamins and the use of nitrogen scavengers. The reader will find here a brief overview describing the most relevant aspects of the clinical management of UCDs in an attempt to raise awareness for this important group of rare diseases.

The effects of low-protein diet (LPD) on kidney function and nutrition in nephropathy are so far unclear.To investigate the effect of LPD on kidney function and nutrition.PubMed, Embase and Cochrane library up to January 2019 and references of retrieved relevant articles.Twenty-nine studies with 1784 individuals in the LPD arm and 1782 individuals in the normal protein diet were identified. Compared with normal protein diet, LPD significantly reduced BUN (WMD -20.756 mg/dl; 95% CI: -33.969 to -7.544 mg/dl; P = 0.002), UREA (WMD -1.400 g/24 h; 95% CI: -1.713 to -1.088 mmol/L; P 0.001), proteinuria (WMD -0.416 g/24 h; 95% CI: -0.715 to -0.117 g/24 h; P = 0.006), body weight (WMD -2.757 kg; 95% CI: -3.890 to 1.623 kg; P 0.001) and BMI (WMD -0.646 kg/mLow-protein diet was significantly associated with improvement of nephropathy, but LPD increases the risk of malnutrition such as BMI. The present meta-analysis provides evidence that LPD was associated with malnutrition, and high-quality RCTs with multi-center and large simple-size should be performed to confirm the present findings.

This study was conducted to evaluate the effects of different levels of crude protein (CP) and protease on nitrogen (N) utilization, nutrient digestibility, and growth performance in growing pigs. A total of six crossbred ([Landrace × Yorkshire] × Duroc) barrows were individually accepted in 1.2 m × 0.7 m × 0.96 m stainless steel metabolism cages. The pigs (average initial body weight of 27.91 ± 1.84 kg) randomly assigned to six diets with six weeks (6 × 6 Latin square design). The experiment was carried out in an environment with a temperature of 23 ± 1.5°C, a relative humidity of 83 ± 2.3% and a wind speed of 0.25 ± 0.03 m/s. The dietary treatments were arranged in a 2 × 3 factorial design with two levels of CP (15.3% or 17.1%) and three levels of protease (0 ppm, 150 ppm, or 300 ppm). The average daily gain and gain to feed ratio (G:F) tended to increase (p = 0.074) with increasing amounts of protease. The low CP level diet reduced (p < 0.050) urinary and fecal N concentrations, the total N excretion in feces, and increased (p < 0.050) N retention. Different protease levels in the diet did not affect (p > 0.05) at N intake, but supplementation of the diets with 300 ppm protease decreased (p < 0.050) the N concentration in urine and feces and tended to increase (p = 0.061) the percentage of N retention retained of the total N intake. The dietary CP level did not affect (p > 0.050) the apparent total tract digestibility (ATTD) of dry matter, digestible energy (DE), and metabolic energy (ME), but diet supplementation with 300 ppm protease showed higher (p < 0.050) ATTD of DE and ME than in the protease-free diet. Therefore, a low protein diet with protease could improve the utilization of nitrogen, thereby reducing the negative effect of N excretion into the environment while maintaining or increasing growth performance compared to a high protein diet.

Background Dietary protein deficiency and amino acid imbalance cause hepatic fat accumulation. We previously demonstrated that only arginine deficiency or total amino acid deficiency in a diet caused significant hepatic triglyceride (TG) accumulation in young Wistar rats. In this study, we explored the mechanisms of fatty liver formation in these models. Methods We fed 6-week-old male Wistar rats a control diet (containing an amino acid mixture equivalent to 15% protein), a low-total-amino acid diet (equivalent to 5% protein; 5PAA), and a low-arginine diet (only the arginine content is as low as that of the 5PAA diet) for 2 weeks. Results Much greater hepatic TG accumulation was observed in the low-arginine group than in the low-total-amino acid group. The lipid consumption rate and fatty acid uptake in the liver did not significantly differ between the groups. In contrast, the low-total-amino acid diet potentiated insulin sensitivity and related signaling in the liver and enhanced de novo lipogenesis. The low-arginine diet also inhibited hepatic very-low-density lipoprotein secretion without affecting hepatic insulin signaling and lipogenesis. Conclusions Although the arginine content of the low-arginine diet was as low as that of the low-total-amino acid diet, the two diets caused fatty liver via completely different mechanisms. Enhanced lipogenesis was the primary cause of a low-protein diet-induced fatty liver, whereas lower very-low-density lipoprotein secretion caused low-arginine diet-induced fatty liver.

Maternal nutrition is crucial for the offspring's skeleton development and the onset of osteoporosis later in life. While maternal low protein diet has been shown to regulate bone mass negatively, the effect of a high protein diet (HP) remains unexplored. Here, we found that C57BL/6 mice fed with HP delivered offspring with decreased skeletal mineralization at birth and reduced bone mass throughout their life due to a decline in their osteoblast maturation. A small RNA sequencing study revealed that miR-24-1-5p was highly upregulated in HP group osteoblasts. Target prediction and validation studies identified SMAD-5 as a direct target of miR-24-1-5p. Furthermore, mimic and inhibitor studies showed a negative correlation between miR-24-1-5p expression and osteoblast function. Moreover, ex vivo inhibition of miR-24-1-5p reversed the reduced maturation and SMAD-5 expression in the HP group osteoblasts. Together, we show that maternal HP diminishes the bone mass of the offspring through miR-24-1-5p.

BACKGROUND: Though it is well established that neonatal nutrition plays a major role in lifelong offspring health, the mechanisms underpinning this have not been well defined. Early postnatal accelerated growth resulting from maternal nutritional status is associated with increased appetite and body weight. Likewise, slow growth correlates with decreased appetite and body weight. Food consumption and food-seeking behaviour are directly modulated by central serotonergic (5-hydroxytryptamine, 5-HT) pathways. This study examined the effect of a rat maternal postnatal low protein (PLP) diet on 5-HT receptor mediated food intake in offspring. METHODS: Microarray analyses, in situ hybridization or laser capture microdissection of the ARC followed by RT-PCR were used to identify genes up- or down-regulated in the arcuate nucleus of the hypothalamus (ARC) of 3-month-old male PLP rats. Third ventricle cannulation was used to identify altered sensitivity to serotonin receptor agonists and antagonists with respect to food intake. RESULTS: Male PLP offspring consumed less food and had lower growth rates up to 3 months of age compared with Control offspring from dams fed a normal diet. In total, 97 genes were upregulated including the 5-HT5A receptor (5-HT5AR) and 149 downregulated genes in PLP rats compared with Controls. The former obesity medication fenfluramine and the 5-HT receptor agonist 5-Carboxamidotryptamine (5-CT) significantly suppressed food intake in both groups, but the PLP offspring were more sensitive to d-fenfluramine and 5-CT compared with Controls. The effect of 5-CT was antagonized by the 5-HT5AR antagonist SB699551. 5-CT also reduced NPY-induced hyperphagia in both Control and PLP rats but was more effective in PLP offspring. CONCLUSIONS: Postnatal low protein programming of growth in rats enhances the central effects of serotonin on appetite by increasing hypothalamic 5-HT5AR expression and sensitivity. These findings provide insight into the possible mechanisms through which a maternal low protein diet during lactation programs reduced growth and appetite in offspring.